Cardiogenic shock (CGS) remains a significant clinical problem in cardiovascular medicine. Although history shows event rates have improved, they remain substantial. In 1942, the observations of Stead1 of shock syndrome resulting from failure of the heart were published, and death at this time in CGS was expected, that is, it was reported at 100%. Goldberg et al2 in 1977 to 1985 reported in-hospital mortality rates from CGS of 74% to 81%. Since the introduction of early percutaneous coronary intervention (P-PCI) for ST-segment–elevation myocardial infarction (STEMI), there has been a reduction in mortality from CGS. Even so, in the SHOCK trial (Should we Emergently Revascularise Occluded arteries for Cardiogenic Shock), the 30-day mortality of CGS patients randomized to early revascularization was 46.7%,3 and it has not changed in the past 16 years despite further pharmacological development (such as the TRIUMPH study4 [A Phase III International, Multi-Center, Prospective, Randomized, Double-Blind, Placebo-Controlled Study to Assess the Safety and Efficacy of Nitric Oxide Synthase Inhibition With Tilarginine Acetate Injection in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction] testing the inducible nitric oxide synthase inhibitor tilarginine) and the introduction and testing of devices to support the myocardium such as the Intra Aortic Balloon Pump (eg, as in the IABP-II study5 [Intra-Aortic Balloon Pump]). Indeed to add to the problem, there have been data to suggest that CGS rates are rising. Kolte et al6 reported in 2014 that among 1,990,486 reviewed patients, the incidence of CGS rose from 6.5% in 2003 to 10.1% in 2010, which is likely to be because of improvements in very early mortality associated with P-PCI. Further insights come from Kunadian et al,7 who analyzed the data from the UK British Cardiovascular Intervention Society (BCIS) National Cardiovascular Outcomes Research (NICOR) database and also reported …